“Brother, Can You Spare the Time?”: Psychotherapists Don’t Reach out to the Unemployed

Our families, friends, and true companionship are thus among consumerism’s principal casualties…We are hollowing out whole areas of life, of individual and social autonomy, of community, and of nature, and, if we don’t soon wake up, we will lose the chance to return, to reclaim ourselves, our neglected society, our battered world, because there will be nothing left to reclaim, nothing left to return to. -Gus Speth – America the Possible: Manifesto for a New Economy (New Haven: Yale University Press, 2012).

Psychotherapists of all disciplines have long thought of themselves as social advocates. We’ve been taught that individuals are embedded in families, and in extended families. These families are embedded in neighborhoods, cities, regions and countries. Ultimately, climate decimation is teaching us that countries are embedded in a shrinking planet that is seriously hurting.

So I began a research project to answer the questions “How responsive are psychotherapists today to the needs of their local communities?” “How do they reach out to those who are in economic as well as psychological pain?” “To what extent does their advertising suggest that they are well aware that the western world is in the worst economic crisis since the last Great Depression?”

I made the task easy for myself. I chose seven cities that have the worst rates of unemployment and related social problems, then did a Google search. I had written previously about how unresponsive psychologists were during the last Great Depression, actually appearing to find the topic of world economic hardship unworthy of study. Surely in an age of global networking, instantaneous news, and easy mobility, we would see psychotherapists announcing their willingness to help the unemployed, not just those still prosperous “worried well.” At least acknowledge that these are hard times.

Alas, little has changed.

My research found scant evidence in advertising profiles that psychotherapists in private or group private practices are aware or responsive to the economic crisis that is overwhelming their cities. While they may identify specific stressors that are the result of joblessness, they virtually ignore acknowledging the social, economic, and environmental issues that are dominant worries for many urban Americans today.

Seven Worst-Hit Cities

Below are the seven cities having both high unemployment and related social issues. In the parenthesis are the “official” unemployment statistics for that population:

El Centro, CA (30.3%)

Yuma, AZ (28.7%)

Rockford, IL (15.7%)

Riverside, CA (15.2%)

Detroit, MI (14.3%)

Los Angeles (12.5%)

Cleveland, OH (9.3%)

Those of you who read John Williams’ “Shadow Statistics” knows that you have to add at least 9 points (he says 14 points based on governments own stats) on to those numbers, if you were to take into account discouraged workers, involuntarily part-time workers, and the like. So counting the truly under- or unemployed we learn that El Centro, CA as a city with 4-5 of every 10 people without a job, could have twice as many workers unemployed than during the last Great Depression.

In Search for a Listening Ear for the ‘Lost-My-Jobbers’

I put myself in the mindset of an average person who has been laid off. I want to find someone to talk about it.

I go to the internet, and read through the descriptions found on the first two pages of a Google search – keyword: “therapist” and then individually add each of the worst hit cities listed above—(e.g. “Therapist” and “Cleveland, OH”).

Here is what I found:

There were hundreds of listings. Most describe themselves as “compassionate and kind.” Some offered koans like: “Each person is different, and we are all alike;” or nautical themes like “helping you navigate your way through life’s difficulties…” They promised to help me “reach [my] full potential.” Some asked the reader probing questions like: “Are you falling apart?”

None of them mentioned that the planet is falling apart.

Most talk about “meaningful change” that will help me to discover my “true self.” Does this include economic change that has caused chaos in the lives of so many people?

And when I’m asked whether my “productivity at work” is off, I imagine I might blame myself if I were unemployed, asking: “Is that the reason I’m not working? Was I unproductive?” Why don’t they mention the massive lay-offs that are happening in their cities? Why don’t they mention the emotional hardship unemployment brings?

Some agencies clearly state their preference for seeing only the remaining “high- functioning clients” “seeking more fulfillment…and joy in their lives.” They also consult with employers to “uncover ways to reduce cost, [and] enhance employee morale.”

“Employee Morale” is a big problems when you let go a significant portions of your work force. Often larger corporations hire “motivational speakers” days after the layoffs are announced, to promote a “positive attitude” as the “key to success” for their remaining work staff. I wrote about this phenomenon in 2010:

In 1994, the same day that AT&T announced it would lay off fifteen thousand workers, it sent its San Francisco staff to a big-tent motivational lecture by Zig Ziglar who told the crowd:

No one in Los Angeles, CA mentioned that residence live in one of the most expensive housing market in the country, with a sharp rise in the crime rate. Nobody in Riverdale, CA mentioned increasing poverty rates or a rising level of pollution that is impacting the children.

In Cleveland, OH, a city with more robberies per 100,000, than any other city in the USA, a psychotherapist proclaims: “Clients deserve to get what they want.”

“Okay,” I mused, “I have a list for you: I want my job back; and a planet with half the population, a city that is safe and neighborly, and cheap gasoline.”

Sometimes the listing shocked me with the insensitivity shown–like the therapist who worked with parents who argued: “The cost of services is less than the cost of a child’s funeral…”

“I Get It. Times are Hard.”

I wasn’t looking for much. I just wanted some acknowledgement that the person clients were going to open up to, to reveal their deepest fears to, actually recognized larger scary concerns.

In Detroit, it is great to “shine my light,” but I wanted some indication that the psychotherapist knew that the city’s lights were being shut off.

I found one:

“Hello, we live in a very stressful time and things are becoming more difficult for couples, families and children every day. I have over 7 years of clinical experience and I understand many of the societal, family, and interpersonal factors that contribute to the challenges we face today.” Gerald Mc Gee, MSW, LICSW.

Thank you, Mr. Mc Gee.

In Rockford, Il, a city as hard hit as during the Great Depression, David Heuser, a minister, wrote:

“Lack of insurance should not be an obstacle to receiving help. If you do not have insurance, if money is tight, I am willing to discuss with you how to deal with the financial arrangements of receiving counseling while dealing with the real issues that are important to you.” Mr. David Heuser, Counselor , LCPC , CADC , MSEd, MDiv

Bless you, Reverend.

Of perhaps hundreds of profiles I read in the seven worst cities in the US for unemployment, pollution, or crime, only these two profiles gave any hint that clinicians knew that bad things were happening to good people.

Many of the therapists claimed to be “practical” or “down to earth,” but none had anything to say about the deteriorating condition of the Earth or the fact that you had to be “practically blind” to not see the obvious: the cities they practiced in were financial war zones.

A Significant Source of Stress

As professions, we know the impact of terrible economic times. Information is out there. Seventy-eight percent of Americans report money as a “significant source of stress” (APA, 2009). Economists Daniel Sullivan and Till von Wachter estimated “a 50 to 100 percent increase in death rates for older male workers in the years immediately following a job loss, if they previously had been consistently employed,” as well as a higher risk of suicide, disease and divorce.

And yet, only two psychotherapists gave any indication of the impact of job loss or community degradation in their profiles?

Position Mergers not Work Sharing

Countries like Germany are well aware of the emotional damage caused by unemployment, and have instituted ‘workshares,’ to keeps workers from being laid off. The German government helps companies keep employees on their payrolls by subsidizing their wages with the money saved on unemployment benefits. All work fewer hours, but all still work. In contrast, in the US, managers are merging two jobs, and increasing the unemployment rolls.

The Stress of Being Unemployed

Food lines in El Centro, CA.Modern-Day “Bread Lines”

Not doing productive work does terrible things to a person. According to the APA, the chances of depression, anxiety, psychosomatic symptoms, low subjective well-being and poor self-esteem double with unemployment. And those still working often end up with a heavier work load and the constant fear and anxiety that they’ll be next. Parental job loss even increases the incidents of punitive and arbitrary punishment of children.

And unemployment doesn’t only impact individuals, it impacts entire communities.

More from the APA:

Widespread unemployment in neighborhoods reduces resources, which may result in inadequate and low-quality housing, underfunded schools, restricted access to services and public transportation, and limited opportunities for employment, making it more difficult for people to return to work (Brisson, Roll, & East, 2009). Unemployed persons also report less neighborhood belonging than their employed counterparts, a finding with implications for neighborhood safety and community well-being (Steward et al., 2009).

While APA does call for extending the Temporary Assistance for Needy Families program, it continues to advocate for more research on the psychological impacts of unemployment, and pushes job re-training. I argue that we know plenty about these impacts, and retraining only works if there are actual jobs to train for. Often these programs provide good jobs only for the workers who run them. Those who entered the computer programming field after being “retrained” can attest to the impact of repeated job displacement.

A Call to Action:

In the worst-hit cities, and indeed all over the USA, grass root action is happening, and I would like to invite my colleagues to join it or initiate it in their own communities. We need to radically transform the way we provide mental health in this country, one psychotherapist at a time.

Our profession has become so tethered to health insurance companies, that we’ve stopped considering those without insurance coverage as “client eligible.” The unemployed fall into this category.

It is clear that economic and psychological insecurity due to employment displacement is a real psychological issue. How do you ignore 40% unemployment or underemployment? How does that not get mentioned as a “specialty” under “problems treated”? It is not enough to call it a “loss” or “life transition.”

And the silence about the context of psychological suffering in these profiles sends another message implicit: Silence says that economic hardship, rising crime, deteriorating environmental conditions, and sky-rocketing energy costs aren’t appropriate issues to discuss in psychotherapists’ “safe offices.” The message is “your pain is not connected to your deteriorating world.”

Reimbursed

Some will argue that those in financial need are served by public mental health clinics, and don’t belong in private psychotherapy offices. This argument is spurious, at a time when funding to pay for public services are dwindling. The mental health clinic I worked at that served the poor exclusively had a six-month waiting list.

If psychotherapy is truly a ‘calling’ where empathy reigns, I urge my colleagues to find psychologically sound methods of providing these services to those in need, regardless of their financial situation.

And because productive work enhances mental health, “Sliding scales” and hand-outs aren’t the best solutions.

When the Great Depression fell upon the American public, Self-Help organizations sprang up as a “spontaneous mass movement” and became a part of daily life for many people. By the end of 1932, there were self-help organizations in over 37 states with 300,000 members (equivalent to 2.1 million people today). Their work involved direct exchanges of goods and services (partially in cash), cooperative production for sale or trade. The largest group, in Seattle, WA, the Unemployed Citizens League (UCL) had twenty-two local commissaries around the city where food and firewood was available for exchange for every type of service and commodity from home repairs to doctors’ bills. Local farmers gave unmarketable fruits and vegetables over to their members to pick and people gained the right to cut firewood on scrub timberland.

Bartering?

These systems are not direct bartering. “Bartering” poses ethical dilemmas for therapists and can, for example, muddy the therapeutic relationship. Instead, trading system “clients” are in no way obligated to the therapist directly. They instead are obligated to the community, “paying back” their psychotherapy by delivering/selling something to another trader in the community. It is, in the true sense of the word, a “favor bank.”

Giving to the War Effort

Today, as during World War I, psychotherapists have rallied to help returning veterans and the US Military, and this effort demonstrates how effective Community Exchanges are as applied to psychotherapy. CES organizations like Give An Hour , ask clinical volunteer professionals to give an hour of their time to provide critical mental health services to U.S. troops and their families who have served in Afghanistan and Iraq. This organization is proof that such a system can work well for our profession.

Surely the economic ‘War on Workers’ deserves our attention no less.

The Dangers of Psychological Terrorism

I’ve developed a deep respect for how powerfully psychology frames reality. Misuse this power, and we pathologize a person’s emotional reactions, attributing psychological symptoms, such as anxiety and depression to past traumas, when these reactions are perfectly appropriate given the current situation or potential threat that presents itself. The sorrow over the death of a parent, for example, is not a mental illness, it is an appropriate emotional response to what has happened to you. Unemployment and the resulting social and economic damage is no different.

When we pathologize predictable responses to life’s difficulties, and disconnect actual events from common emotion reactions to it, we inflict what I call “Psychological Terrorism.”

When, as a group, we psychotherapists don’t acknowledge economic hardship, energy depletion, or environmental degradation as legitimate concerns for exploration in therapy, we send a powerful message to people implying that these aren’t “real” concerns, or that these are “personal” as opposed to “collective” issues, that require only personal help. Referring the un- or under employed to movements like UCubed allows them to see themselves as part of the 31 million Americans without work. It contextualizes their pain. It promotes collective action. It enhances mental health.

While mentioning “I know these are hard times” or “I’m sensitive to environmental concerns’ in their advertising will hardly be a revolutionary act, it is an initial step in first and foremost labeling this severe economic depression as “real.” Imagine if physicians, dentists…all health and allied mental health professionals included in their advertising the phrase “We know you are hurting from this bad economy. Let us know how we can help you get the help you need.”

This type of advertising says “It’s real. It is happening to all of us, not just you.” It labels these concerns as legitimate stressors that intensify the need for treatment, as well as being a legitimate topic for treatment.

Community Spirit Lives

Community Exchange Systems (CES), Local Exchange Trading Systems (LETS), Mutual Credit trading systems or Time Banks are trading systems that are truly workable in communities decimated by a crumbling economy. When psychotherapists join them, participate in them, it tells our communities that we are aware of what is happening, and we are active participants in healing the suffering. We put our own labor on par with that of other community workers and we are willing to exchange that labor to those who are willing to work for others. Our very participation in such CES organizations are bolstering the care we provide, by providing the opportunity to work.

We Live in Historically Significant Times

My colleagues, let us not be judged harshly by history yet again. Eighty years ago, we responded, as a group, to the war effort, while ignoring the unemployed:

“When the United States entered the First World War, psychologists,

We are used to these pictures. Women and children weren’t allowed in these lines. They were taken around back, when they showed up for food.

as an associated group, volunteered their professional services. Their contribution was considerable, both to the conduct of the War and to psychology.

When the United States entered the big world depression, psychologists did nothing and, as a group, have so far done nothing.

For nearly 10 years we have suffered through a national social and economic crisis; yet, from an examination of our professional journals and the programs of our professional meetings, one might conclude that psychologists were oblivious of the fact that our social institutions are rattling about our ears.

In fact, the world at large is as ignorant of the possible contributions of psychologists as psychologists appear to be about the world.”

We can take action, as a profession, developing psychologically savvy and effective ways to empower those now ravaged by the second Greater Depression. We can add our voices to the growing choirs that say “growth is a dead end on a finite planet” and that a “debt-based economy harms people.” We can tell our clients “It isn’t you. You are living in a time of great social upheaval. Don’t blame yourself.”

We can refuse to participate in Psychological Terrorism.

We know and teach that relationships, not material possessions bring us happiness. Now we must model that conviction in our work, by interweaving our efforts into our wounded communities, giving and receiving services, not only money.

By our actions, we demonstrate our motivation to change our world for the better and earn the label “healers.”

********

Dr. Kathy McMahon, “The Peak Shrink,” is a clinical psychologist who chides herself, as well as her colleagues, for not pushing harder to find better ways to reach the un- and under-employed in her community. She’s learned something about unemployment when her husband lost his business and was un- or under employed for 18 months. She’s learned about “job merging” when her “promotion” was withdrawn and “combined into” another existing higher-up position. You can critique her own professional profile by entering in “Psychologist” and “Cummington, MA,” or just Google Kathy McMahon.

Kathy McMahon Psy.D. is a clinical psychologist who is internationally known for her writing about the psychological impacts of Peak Oil, climate change, and economic collapse. She's written for Honda Motors, and has been featured in American Prospect, Greenpeace International, the Vancouver Sun, Freakonomics, Itulip, Ecoshock Radio, and Peak Moments Television.

Comments

Thanks for this, Kathy. It is as though we have deemed any attempt to look outward and connect with the system at large, especially nature, a forbidden taboo. We have trained our minds to be reductionist and to focus and look inwards at pieces and parts to the point that we are blinded and disintegrated from both the larger system and the natural world.

The difference between situational and clinical disorders is great, as you say. One could argue that almost everyone is suffering from situational depression in the current circumstances, especially if they have not come to grips with the losses piling up quickly in their personal situations: work roles, ability to consume as therapy, changes in the economy, and so on. I agree that many therapists no longer see the differences in causation and thus also in methods of treatment. We need nature therapy and cognitive right brain retraining (art therapy?) in order to regain the big picture.

Excellent point, Mary, and thanks for the video. Even in university programs, designed to teach about “sustainability” we see financial arguments being made about how we can get more by taking less, or putting a dollar amount on “natural resources.” We try so desperately to keep the conversation logical and detached and measurable.
In the same way, therapy techniques that are considered “valid” measure such things as how quickly you return to your job, or how many days you take off from work. We’ve lost the notion that the original translation for “ego” was much closer to “soul.” The psychiatrists in the US couldn’t stand such an “unscientific” term. We like “personality” in place of “character.”
My call to my colleagues is to go beyond their offices and see the misery and the suffering. To invite that into their “safe” world. To contextualize it, as you provide solace. We have so much to do.

“The psychiatrists in the US couldn’t stand such an “unscientific” term.”

Science has jumped the shark. My first essay assignment in my course is affective; how students feel about the world. One of my students wrote a great essay, which I will post on my website on Saturday. Because the essay is heartfelt and values emotions, the student did not want to include a name, for fear of being viewed by professors as lacking “scientific legitimacy.” What have we come to, that science cannot include feelings? Isn’t feelings what guides our discrimination and prioritization between opposing values? Our scientific guidance system today values the needs of the organization, primarily the value of profit.http://www.nwlink.com/~donclark/hrd/bloom.html#affective

Instead we should be asking ourselves, “What is the responsible thing to do with respect to the world? Can our society afford to be doing some of the research and tech development that we are doing?” Instead, normal feelings have been hollowed out, medicated and suppressed. Traditional values are suppressed while the guiding values of the corporation take over.

When the curtain is pulled back on our economy and the feelings come rushing back in for Americans, what will the impact be on our caring professions? Especially when no one can afford the counseling?

I believe it’s a nuanced issue here and we have a polemic here, if you will. The writer argues the problems of living are the reason for depression anxiety, bipolar disorder, etc. . I am taking liberty here and interpreting a bit. As a psychiatrist in Canada I face this question every day with my patients in a public clinic. If the narrative is the medical model then everybody who is under stress experiences the stress response and can develop the medical symptoms of depression. If the model is social then these are all the normal responses to crisis. I think the problem lies in the word normal. For me treatment can reverse the stress response using medications. Not treating because it’s social withholds care. The difficulty then lies in justify medicating somebody without giving them a mental illness as a diagnosis. Again I think taking a functional approach and seeing this as a stress response that leads to neurohormonal imbalance permits you to treat the symptoms and return the person to health. In sum, I don’t know what you call this: Is this treating mental illness or an imbalance. In either case I think treating the person can be done effectively without blaming them or pathologizing them. A boat the capsizes is still an elegant vessel that needs righting. One can acknowledge the social factors, yes, but health must be restored. Fighting social justice may leave your client lost in the dust.

Anonymous, I think that the interpretations and liberties you admit to taking have you veering far afield from the Peak Shrink’s essential point, which is the oblivious posture of psychotherapists towards the mental impact of the decay that envelopes their marketplace. This is apparent, according to the good doctor, in the way in which these psychotherapists describe their services in their professional profiles. It is not unlike a physician working at the epi-center of an epidemic confining her remarks to the discussion of the benefits of fresh air and exercise.

In an epidemic, we would attempt to take health measures to reduce the spread of the disease. We would not tell people that they hadn’t taken good care of their health and therefore are sick (even if for some that might be true). We would explain to them that there is an epidemic and they “caught” the disease. Of course we would treat the symptoms. That’s just good common sense. But we would be clear that our hospital is treating an epidemic, not just a bunch of people who happen to catch an illness.

With regards to diagnosis, I spend quite a long time addressing that in a trilogy of posts you can find listed under “Best of POB” under the heading: “For Professional Mental Health Workers & Activists.” Diagnosing mental illness is so different fundamentally from diagnosing diabetes. Perhaps that will change in time.

I also would caution the reader that nobody in neurobiology believes that medications “rights” a “wrong” brain. I know you didn’t explicitly say that, but your metaphor does. Psychotropics definitely impact and change brain chemistry (and many would argue at a considerable long-term cost) and for many produce immediately positive results, but the “ship” isn’t “righted.” The ship, perhaps, is put on a tanker and carried around for as long as you keep taking the drug. Metaphors are important to helping people understand their situation.
See http://www.madinamerica.com/author/rwhitaker/

Wow, thanks for such a boldly stated and humane article. I would add to the concerns that lack of accessibility to legitimate forms of therapy often creates an environmental where charlatans and snake oil salesmen flourish– as victims will grasp at any and all straws for help–yet another moral hazard that conflates the first.

One last analogy–this is a global economic depression that we are entering. Are we going to give the world a pill for its depression? Maybe feed it some more greenbacks?

Situational depression is a sign that something in your system needs to change. In an individual who has had a loss, that sadness means s/he need to adapt to a situation where something within the milieu is missing. If one loses one’s spouse, for example, many changes will have to occur. Medication without adaptation in that circumstance is inappropriate. But that is the state of pyschotherapeutics in western medicine as it is currently practiced.

We will treat our global depression the same way. Continue motoring on on the same course we’re on, since any change at this point in overshoot is dangerous to the status quo. We will look for economic medications to whitewash (greenwash?) the problems. That denial will just makes things worse, since adaptation is what is required here.

Years ago, I was a social worker (MSW, University of Texas) and one of the most maddening things I had to deal with were psychologists who didn’t have a clue about the situations people were living in. I would haul people to the psychologist, and the psychologist would diagnose some disorder, virtually ignoring the description from me about the social and economic travails these clients were facing. To me, the fact they were coping at all was just short of miraculous, a testament to human ingenuity and spirit. To the psychologist, it was something intrinsic to the individual that created the problems in the first place. Thank you for being one of the enlightened ones. When a person loses their home, their job, and all hope of re-instating their former life, that person is going to be troubled and it may not be because of some personality flaw. The difference in analysis leads to very different solutions. The “flawed individual” approach will lead to therapy and drugs. The social injustice approach will lead to advocacy and job programs and free clinics. I’m not saying therapy and drugs are wrong, I’m just saying sometimes it’s just not the first thing you need to be doing.

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Meet Dr. K, “The Peak Shrink”

Kathy McMahon Psy.D. is a clinical psychologist who is internationally known for her writing about the psychological impacts of Peak Oil, climate change, and economic collapse. She's written for Honda Motors, and has been featured in American Prospect, Greenpeace International, the Vancouver Sun, Freakonomics, Itulip, Ecoshock Radio, and Peak Moments Television.